1
|
Chen Y, Zhang M, Wang G, Hong X, Wang X, Mueller NT. Mother's age at menarche is associated with odds of preterm delivery: A case-control study. BJOG 2024; 131:424-432. [PMID: 37661294 PMCID: PMC10872971 DOI: 10.1111/1471-0528.17648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE There is a secular trend towards earlier age of menarche in the US and globally. Earlier age at menarche (AAM) has been associated with metabolic disorders that increase risk for preterm delivery (PTD), yet no studies in the US have investigated whether AAM influences risk of PTD. This study tested the hypothesis that AAM is associated with PTD. DESIGN A case-control study. SETTING The Boston Medical Center (BMC) in Boston, Massachusetts. POPULATION OR SAMPLE 8264 mother-newborn dyads enrolled at birth at BMC between 1998 and 2019, of which 2242 mothers had PTD (cases) and 6022 did not have PTD (controls). METHODS Multivariable-adjusted logistic regression models and restricted cubic splines were used to examine the association between AAM and risk of PTD. The combined impact of AAM and age at delivery on the risk of PTD was also examined. MAIN OUTCOME MEASURES Preterm delivery and gestational age (GA) was defined by maternal last menstrual period and early ultrasound documented in medical records. RESULTS Maternal age at delivery was 28.1 ± 6.5 years and AAM was 12.85 ± 1.86 years. Multivariable-adjusted cubic spline suggested an inverse dose-response association of AAM with odds of PTD and, consistently, a positive association with GA. A 1-year earlier AAM was associated with 5% (95% CI 2%-8%) higher odds of PTD, after adjustment for maternal year of birth, parity, maternal place of birth, education, smoking status and Mediterranean-style diet score. The association between AAM and PTD was stronger among older mothers whose age at delivery was ≥35 years. CONCLUSIONS Earlier AAM is associated with higher odds for PTD, and this association is stronger among women at advanced reproductive age.
Collapse
Affiliation(s)
- Yingan Chen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Lifecourse Epidemiology of Adiposity & Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mingyu Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Guoying Wang
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Xiumei Hong
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Xiaobin Wang
- Center on Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
- Lifecourse Epidemiology of Adiposity & Diabetes Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
2
|
Ratliff A, Pekala D, Wenner P. Plasticity in Preganglionic and Postganglionic Neurons of the Sympathetic Nervous System during Embryonic Development. eNeuro 2023; 10:ENEURO.0297-23.2023. [PMID: 37833062 PMCID: PMC10630925 DOI: 10.1523/eneuro.0297-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/30/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Sympathetic preganglionic neurons (SPNs) are the final output neurons from the central arm of the autonomic nervous system. Therefore, SPNs represent a crucial component of the sympathetic nervous system for integrating several inputs before driving the postganglionic neurons (PGNs) in the periphery to control end organ function. The mechanisms which establish and regulate baseline sympathetic tone and overall excitability of SPNs and PGNs are poorly understood. The SPNs are also known as the autonomic motoneurons (MNs) as they arise from the same progenitor line as somatic MNs that innervate skeletal muscles. Previously our group has identified a rich repertoire of homeostatic plasticity (HP) mechanisms in somatic MNs of the embryonic chick following in vivo synaptic blockade. Here, using the same model system, we examined whether SPNs exhibit similar homeostatic capabilities to that of somatic MNs. Indeed, we found that after 2-d reduction of excitatory synaptic input, SPNs showed a significant increase in intracellular chloride levels, the mechanism underlying GABAergic synaptic scaling in this system. This form of HP could therefore play a role in the early establishment of a setpoint of excitability in this part of the sympathetic nervous system. Next, we asked whether homeostatic mechanisms are expressed in the synaptic targets of SPNs, the PGNs. In this case we blocked synaptic input to PGNs in vivo (48-h treatment), or acutely ex vivo, however neither treatment induced homeostatic adjustments in PGN excitability. We discuss differences in the homeostatic capacity between the central and peripheral component of the sympathetic nervous system.
Collapse
Affiliation(s)
- April Ratliff
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322
| | - Dobromila Pekala
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322
| | - Peter Wenner
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322
| |
Collapse
|
3
|
Brewer PL, D'Agata AL, Roberts MB, Saquib N, Schnatz PF, Manson J, Eaton CB, Sullivan MC. The co-occurrence and cumulative prevalence of hypertension, rheumatoid arthritis, and hypothyroidism in preterm-born women in the Women's Health Initiative. J Dev Orig Health Dis 2023; 14:459-468. [PMID: 37198934 DOI: 10.1017/s2040174423000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Emerging evidence suggests that preterm-born individuals (<37 weeks gestation) are at increased risk of developing chronic health conditions in adulthood. This study compared the prevalence, co-occurrence, and cumulative prevalence of three female predominant chronic health conditions - hypertension, rheumatoid arthritis [RA], and hypothyroidism - alone and concurrently. Of 82,514 U.S. women aged 50-79 years enrolled in the Women's Health Initiative, 2,303 self-reported being born preterm. Logistic regression was used to analyze the prevalence of each condition at enrollment with birth status (preterm, full term). Multinomial logistic regression models analyzed the association between birth status and each condition alone and concurrently. Outcome variables using the 3 conditions were created to give 8 categories ranging from no disease, each condition alone, two-way combinations, to having all three conditions. The models adjusted for age, race/ethnicity, and sociodemographic, lifestyle, and other health-related risk factors. Women born preterm were significantly more likely to have any one or a combination of the selected conditions. In fully adjusted models for individual conditions, the adjusted odds ratios (aORs) were 1.14 (95% CI, 1.04, 1.26) for hypertension, 1.28 (1.12, 1.47) for RA, and 1.12 (1.01, 1.24) for hypothyroidism. Hypothyroidism and RA were the strongest coexisting conditions [aOR 1.69, 95% CI (1.14, 2.51)], followed by hypertension and RA [aOR 1.48, 95% CI (1.20, 1.82)]. The aOR for all three conditions was 1.69 (1.22, 2.35). Perinatal history is pertinent across the life course. Preventive measures and early identification of risk factors and disease in preterm-born individuals are essential to mitigating adverse health outcomes in adulthood.
Collapse
Affiliation(s)
- Pamela L Brewer
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Amy L D'Agata
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, Rhode Island, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - Peter F Schnatz
- Department of Obstetrics and Gynecology and Internal Medicine, Reading Hospital/Tower Health/Drexel University, Reading, Pennsylvania, USA
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Charles B Eaton
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mary C Sullivan
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| |
Collapse
|
4
|
Brewer PL, D'Agata AL, Roberts MB, Wild RA, Shadyab AH, Saquib N, Manson J, Eaton CB, Sullivan MC. Association of Preterm Birth With Prevalent and Incident Hypertension, Early-Onset Hypertension, and Cardiovascular Disease in the Women's Health Initiative. Am J Cardiol 2023; 192:132-138. [PMID: 36791524 DOI: 10.1016/j.amjcard.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
Increasing evidence suggests preterm birth is a risk factor for hypertension and cardiovascular disease (CVD) in adulthood. Whether there is effect modification by hypertension on CVD risk is unknown. To investigate the associations between preterm birth, hypertension, and incident CVD, we identified 2,303 women aged 50 to 79 years who self-reported being born preterm from the Women's Health Initiative. Using multivariable logistic regression, prevalent hypertension at enrollment, age at hypertension diagnosis, and antihypertensive medication use were compared by birth status (preterm, full-term). Risk of incident hypertension, coronary heart disease, and CVD were analyzed using multivariable Cox proportional-hazard models. Both models adjusted for age, race/ethnicity, education, smoking, physical activity, body mass index, and diabetes mellitus. Significant associations were found between preterm birth and prevalent hypertension (37% vs 33.1%; adjusted odds ratio 1.26 [95% confidence interval (CI) 1.15 to 1.28] p = <0.0001), early-onset hypertension (<50 years) (14.7% vs 11.7%; adjusted odds ratio 1.31, 95% CI 1.15 to 1.48, p = <0.0001), and incident hypertension (53.2% vs 51%; ajusted hazard ratio 1.10, 95% CI 1.03 to 1.19, p = 0.008). Preterm-born women reported taking more antihypertensive medications (2.9% vs 2.6%, p = 0.04). Preterm birth had a nonsignificant association with CVD risk, but when stratified by prevalent hypertension, women born preterm without hypertension had elevated CVD risk compared with women born full-term without prevalent hypertension. Women with prevalent hypertension, preterm and full-term, had similar magnitudes of elevations in CVD risk. In conclusion, preterm birth increases the risk of hypertension and coronary heart disease. With 10% of the population born preterm, birth history should be assessed as a CVD risk factor.
Collapse
Affiliation(s)
- Pamela L Brewer
- College of Nursing, University of Rhode Island, Providence, Rhode Island.
| | - Amy L D'Agata
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, Rhode Island
| | - Robert A Wild
- Departments of Biostatistics and Epidemiology; Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Aladdin H Shadyab
- School of Medicine, University of California San Diego, San Diego, California
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi Arabia
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Charles B Eaton
- Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary C Sullivan
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| |
Collapse
|
5
|
Fenton TR, Elmrayed S, Scime NV, Tough SC, Pinto J, Sabet F, Wollny K, Lee Y, Harrison TG, Alladin-Karan B, Kramer MS, Ospina MB, Lorenzetti DL, Madubueze A, Leung AA, Kumar M. Small for date preterm infants and risk of higher blood pressure in later life: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2023. [PMID: 36688258 DOI: 10.1111/ppe.12955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. OBJECTIVES To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size. METHODS A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity. RESULTS We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I2 = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I2 = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains. CONCLUSIONS Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants.
Collapse
Affiliation(s)
- Tanis R Fenton
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Seham Elmrayed
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Global Health and Human Ecology Institute, American University in Cairo, Cairo, Egypt
| | - Natalie V Scime
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jahaira Pinto
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Fatemeh Sabet
- Interior Health Authority, Kelowna, British Columbia, Canada
| | - Krista Wollny
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Yoonshin Lee
- Senior Persons Living Connected, Hong Fook Mental Health Association, Toronto, Ontario, Canada
| | - Tyrone G Harrison
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bibi Alladin-Karan
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Maria B Ospina
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Diane L Lorenzetti
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ada Madubueze
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
In infants with congenital heart disease autonomic dysfunction is associated with pre-operative brain injury. Pediatr Res 2022; 91:1723-1729. [PMID: 34963700 PMCID: PMC9237187 DOI: 10.1038/s41390-021-01931-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Brain injury is a serious and common complication of critical congenital heart disease (CHD). Impaired autonomic development (assessed by heart rate variability (HRV)) is associated with brain injury in other high-risk neonatal populations. OBJECTIVE To determine whether impaired early neonatal HRV is associated with pre-operative brain injury in CHD. METHODS In infants with critical CHD, we evaluated HRV during the first 24 h of cardiac ICU (CICU) admission using time-domain (RMS 1, RMS 2, and alpha 1) and frequency-domain metrics (LF, nLF, HF, nHF). Pre-operative brain magnetic resonance imaging (MRI) was scored for injury using an established system. Spearman's correlation coefficient was used to determine the association between HRV and pre-operative brain injury. RESULTS We enrolled 34 infants with median birth gestational age of 38.8 weeks (IQR 38.1-39.1). Median postnatal age at pre-operative brain MRI was 2 days (IQR 1-3 days). Thirteen infants had MRI evidence of brain injury. RMS 1 and RMS 2 were inversely correlated with pre-operative brain injury. CONCLUSIONS Time-domain metrics of autonomic function measured within the first 24 h of admission to the CICU are associated with pre-operative brain injury, and may perform better than frequency-domain metrics under non-stationary conditions such as critical illness. IMPACT Autonomic dysfunction, measured by heart rate variability (HRV), in early transition is associated with pre-operative brain injury in neonates with critical congenital heart disease. These data extend our earlier findings by providing further evidence for (i) autonomic dysfunction in infants with CHD, and (ii) an association between autonomic dysfunction and brain injury in critically ill neonates. These data support the notion that further investigation of HRV as a biomarker for brain injury risk is warranted in infants with critical CHD.
Collapse
|
7
|
Iyengar A, Bonilla-Félix M. Effects of Prematurity and Growth Restriction on Adult Blood Pressure and Kidney Volume. Adv Chronic Kidney Dis 2022; 29:243-250. [PMID: 36084971 DOI: 10.1053/j.ackd.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Gaining insight into the complex cycle of renal programming and its early-life clinical associations is essential to understand the origins of kidney disease. Prematurity and intrauterine growth restriction are associated with low nephron endowment. This increases the risk of developing hypertension and chronic kidney disease later in life. There is appreciable evidence to support mechanistic links between low nephron endowment secondary to intrauterine events and kidney size, kidney function, and blood pressure in postnatal life. A clear understanding of the cycle of developmental programming and consequences of fetal insults on the kidney is critical. In addition, the impact of events in the early postnatal period (accelerated postnatal growth, development of obesity, exposure to nephrotoxins) on the cardiovascular system and blood pressure of individuals born prematurely or with low birth weight is discussed. In summary, this review draws attention to the concepts of renal programming and nephron endowment and underscores the associations between intrauterine growth restriction, prematurity, and its clinical consequences in adult life.
Collapse
Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | | |
Collapse
|
8
|
Mathewson KJ, McGowan PO, de Vega WC, Morrison KM, Saigal S, Van Lieshout RJ, Schmidt LA. Cumulative risks predict epigenetic age in adult survivors of extremely low birth weight. Dev Psychobiol 2021; 63 Suppl 1:e22222. [PMID: 34964497 DOI: 10.1002/dev.22222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022]
Abstract
Long-term sequelae of extremely low birth weight (ELBW; ≤1000 g) may contribute to accelerated biological aging. This hypothesis was examined by analyzing a range of risk factors with a molecular age marker in adults born at ELBW or normal birth weight (NBW; ≥2500 g). DNAm age-the weighted average of DNA methylation at 353 cytosine-phosphate-guanine (CpG) sites from across the genome-was derived from a sample of 45 ELBW (Mage = 32.35 years) and 47 NBW control (Mage = 32.44 years) adults, using the Illumina 850k BeadChip Array. At two assessments undertaken 9 years apart (at 23 and 32 years), cumulative risks were summed from six domains with potential to affect physiological and psychological health: resting respiratory sinus arrhythmia, blood pressure, basal cortisol, grip strength, body mass index, and self-esteem. At age 32 years, cumulative risks were differentially associated with epigenetic age in ELBW survivors (interaction, p < 0.01). For each additional risk factor they possessed, ELBW survivors (B = 1.43) were biologically 2.16 years older than NBW adults (B = -0.73), by the fourth decade of life. Developmental change, epigenetic maintenance, and intervention targets are discussed.
Collapse
Affiliation(s)
- Karen J Mathewson
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Patrick O McGowan
- Department of Biological Sciences, Cell and Systems Biology, Psychology, and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Wilfred C de Vega
- Department of Biological Sciences, Cell and Systems Biology, Psychology, and Physiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Saroj Saigal
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Louis A Schmidt
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
9
|
Metabolomic Profile of Young Adults Born Preterm. Metabolites 2021; 11:metabo11100697. [PMID: 34677412 PMCID: PMC8538752 DOI: 10.3390/metabo11100697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
Prematurity is a risk factor for the development of chronic adult diseases. Metabolomics can correlate the biochemical changes to a determined phenotype, obtaining real information about the state of health of a subject at that precise moment. Significative differences in the metabolomic profile of preterm newborns compared to those born at term have been already identified at birth. An observational case–control study was performed at the University Hospital of Siena. The aim was to evaluate and compare the metabolomic profiles of young adults born preterm to those born at term. Urinary samples were collected from 67 young adults (18–23 years old) born preterm (mean gestational age of 30 weeks, n = 49), and at term of pregnancy (mean gestational age of 38 weeks, n = 18). The urinary spectra of young adults born preterm was different from those born at term and resembled what was previously described at birth. The Random Forest algorithm gave the best classification (accuracy 82%) and indicated the following metabolites as responsible for the classification: citrate, CH2 creatinine, fumarate and hippurate. Urine spectra are promising tools for the early identification of neonates at risk of disease in adulthood and may provide insight into the pathogenesis and effects of fetal programming and infants’ outcomes.
Collapse
|
10
|
Elmrayed S, Metcalfe A, Brenner D, Wollny K, Fenton TR. Are small-for-gestational-age preterm infants at increased risk of overweight? Statistical pitfalls in overadjusting for body size measures. J Perinatol 2021; 41:1845-1851. [PMID: 33850286 DOI: 10.1038/s41372-021-01050-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of this study is to analyze the effect of adjusting for body measures on the association between small for gestational age (SGA) and overweight at 3 years. STUDY DESIGN Data were obtained from the Preterm Infant Multicenter Growth Study (n = 1089). Logistic regression was used, to adjust for confounders with additional adjustments separately for weight and height at 21 months. Marginal structural models (MSMs) estimated the direct effect of SGA on overweight. RESULTS The crude and adjusted for confounders models yielded null associations between SGA and overweight. Adjusting for height yielded a positive association (odds ratio (OR): 2.31, 95% CI: 0.52-10.26) and adjusting for weight provided a significantly positive association (OR: 6.60, 95% CI: 1.10-37.14). The MSMs, with height and weight held constant, provided no evidence for a direct effect of SGA on overweight (OR: 0.83, 95% CI: 0.14-5.01, OR: 0.71, 95% CI: 0.18-2.81, respectively). CONCLUSION Adjusting for body measures can change the association between SGA and overweight, providing spurious estimates.
Collapse
Affiliation(s)
- Seham Elmrayed
- Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Amy Metcalfe
- Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darren Brenner
- Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Krista Wollny
- Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanis R Fenton
- Department of Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|
11
|
Schlatterer SD, du Plessis AJ. Exposures influencing the developing central autonomic nervous system. Birth Defects Res 2020; 113:845-863. [PMID: 33270364 DOI: 10.1002/bdr2.1847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/04/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022]
Abstract
Autonomic nervous system function is critical for transition from in-utero to ex-utero life and is associated with neurodevelopmental and neuropsychiatric outcomes later in life. Adverse prenatal and neonatal conditions and exposures can impair or alter ANS development and, as a result, may also impact long-term neurodevelopmental outcomes. The objective of this article is to provide a broad overview of the impact of factors that are known to influence autonomic development during the fetal and early neonatal period, including maternal mood and stress during and after pregnancy, fetal growth restriction, congenital heart disease, toxic exposures, and preterm birth. We touch briefly on the typical development of the ANS, then delve into both in-utero and ex-utero maternal and fetal factors that may impact developmental trajectory of the ANS and, thus, have implications in transition and in long-term developmental outcomes. While many types of exposures and conditions have been shown to impact development of the autonomic nervous system, there is still much to be learned about the mechanisms underlying these influences. In the future, more advanced neuromonitoring tools will be required to better understand autonomic development and its influence on long-term neurodevelopmental and neuropsychological function, especially during the fetal period.
Collapse
Affiliation(s)
- Sarah D Schlatterer
- Children's National Hospital, Prenatal Pediatrics Institute, Washington, District of Columbia, USA.,George Washington University School of Health Sciences, Departments of Neurology and Pediatrics, Washington, District of Columbia, USA
| | - Adre J du Plessis
- Children's National Hospital, Prenatal Pediatrics Institute, Washington, District of Columbia, USA.,George Washington University School of Health Sciences, Departments of Neurology and Pediatrics, Washington, District of Columbia, USA
| |
Collapse
|
12
|
Jang MJ, Song YH, Yoon JM, Cheon EJ, Ko KO, Lim JW. Mortality Rate and Major Causes of Death by Gestational Age in Korean Children under 5 Years of Age. J Korean Med Sci 2020; 35:e340. [PMID: 33075854 PMCID: PMC7572229 DOI: 10.3346/jkms.2020.35.e340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preterm birth is associated with increased infant mortality. However, it is not clear whether prematurity is associated with mortality after 1 year of age. There is a lack of research on mortality rate and causes of death after infancy in preterm babies in Korea. We aimed to analyze the mortality rates and causes of deaths up to 5 years of age in Korea. METHODS Using the Microdata Integrated Service of Statistics Korea database, this retrospective cohort study screened infants born between 2010 and 2012. After applying the exclusion criteria, 1,422,913 live births were classified into the following groups by gestational age: those born at < 32 weeks' gestation (n = 10,411), those born between 32 and 36 weeks' gestation (n = 75,657), and those born at ≥ 37 weeks' gestation (n = 1,336,845). The association of gestational age with mortality in infancy (< 1 year of age) and childhood (1-5 years of age) was analyzed, with and without covariates. The major causes of death in infancy and childhood were analyzed by gestational age. RESULTS Overall, 4,930 (0.3%) children died between birth and 5 years of age, with 19.1% of these deaths occurring after infancy. Adjusted hazard ratios (HRs) for infant death were 78.79 (95% confidence interval [CI], 71.33-87.04) and 4.62 (95% CI, 4.07-5.24) for the < 32 and 32-36 weeks groups, respectively, compared to the full-term group; the adjusted HRs for deaths occurring at ages 1-5 years were 9.25 (95% CI, 6.85-12.50) and 2.42 (95% CI, 1.95-3.01), respectively. In infancy, conditions originating in the perinatal period were the most common cause of deaths in the < 32 and 32-36 weeks groups (88.7% and 41.9%, respectively). Contrarily, in the ≥ 37 weeks group, conditions originating in the perinatal period explained 22.7% of infant deaths, with congenital malformations primarily accounting for 29.6% of these deaths. The most common cause of death in children (after infancy) in the < 32 weeks group was perinatal causes (25.0%); in the 32-36 weeks group, congenital malformation and nervous system disease were the common causes (21.7% and 19.1%, respectively). In the ≥ 37 weeks group, injury, poisoning, and other consequences of external causes explained 26.6% of childhood deaths, followed by neoplasms and nervous system disease (15.7% and 14.7%, respectively). CONCLUSION Low gestational age is associated with not only infant mortality but also child mortality. The major causes of death differed by gestational age in infancy and childhood. For the care of preterm infants, especially those born at < 32 weeks' gestation, particular attention and continuous monitoring are needed in consideration of the major causes of deaths until 5 years of age.
Collapse
Affiliation(s)
- Min Jeong Jang
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Young Hwa Song
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Eun Jung Cheon
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Kyung Ok Ko
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea
| | - Jae Woo Lim
- Department of Pediatrics, Konyang University Hospital, Daejeon, Korea.
| |
Collapse
|
13
|
Cardiovascular risk factors in those born preterm - systematic review and meta-analysis. J Dev Orig Health Dis 2020; 12:539-554. [PMID: 33028453 DOI: 10.1017/s2040174420000914] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Emerging evidence demonstrates a link between preterm birth (PTB) and later life cardiovascular disease (CVD). We conducted a systematic review and meta-analysis to compare conventional CVD risk factors between those born preterm and at term. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. The review protocol is registered in PROSPERO (CRD42018095005). CVD risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index, lipid profile, blood glucose, and fasting insulin among those born preterm (<37 weeks' gestation) were compared with those born at term (≥37 weeks' gestation). Subgroup analyses based on gender, age, gestational at birth (<32 weeks' gestation and <28 weeks' gestation), and PTB associated with small for gestational age or average for gestational age were also performed. Fifty-six studies provided data on 308,987 individuals. Being born preterm was associated with 3.26 mmHg (95% confidence interval [CI] 2.08 to 4.44) higher mean SBP and 1.32 mmHg (95% CI: 0.61 to 2.04) higher mean DBP compared to being born at term. Subgroup analyses demonstrated that SBP was higher among (a) preterm compared to term groups from early adolescence until adulthood; (b) females born preterm but not among males born preterm compared to term controls; and (c) those born at <32 weeks or <28 weeks compared to term. Our meta-analyses demonstrate higher SBP and DBP among those born preterm compared to term. The difference in SBP is evident from early adolescence until adulthood.
Collapse
|
14
|
Markopoulou P, Papanikolaou E, Analytis A, Zoumakis E, Siahanidou T. Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis. J Pediatr 2019; 210:69-80.e5. [PMID: 30992219 DOI: 10.1016/j.jpeds.2019.02.041] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if preterm birth is associated with components of the metabolic syndrome in adult life. STUDY DESIGN A structured literature search was performed using PubMed. All comparative studies reported metabolic and cardiovascular outcomes in adults (≥18 years of age) born preterm (<37 weeks of gestation) compared with adults born at term (37-42 weeks of gestation) and published through March 2018 were included. The major outcomes assessed were body mass index, waist circumference, waist-to-hip ratio, fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour SBP, 24-hour DBP, endothelium-dependent brachial artery flow-mediated dilation, carotid intima-media thickness, pulse wave velocity, fasting glucose and insulin, Homeostasis Model Assessment-Estimated Insulin Resistance Index, and lipid profiles. Quality appraisal was performed using a modified version of the Newcastle-Ottawa scale. A meta-analysis was performed for comparable studies which reported sufficient data. RESULTS Forty-three studies were included, including a combined total of 18 295 preterm and 294 063 term-born adults. Prematurity was associated with significantly higher fat mass (P = .03), SBP (P < .0001), DBP (P < .0001), 24-hour SBP (P < .001), and 24-hour DBP (P < .001). Furthermore, preterm-born adults presented higher values of fasting glucose (P = .01), insulin (P = .002), Homeostasis Model Assessment-Estimated Insulin Resistance Index (P = .05), and total cholesterol levels (P = .05) in comparison with adults born at term, in random effect models. No statistically significant difference was found between preterm and term-born adults for the other outcomes studied. CONCLUSIONS Preterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.
Collapse
Affiliation(s)
- Panagiota Markopoulou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Papanikolaou
- Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Analytis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Zoumakis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
15
|
Heidemann LA, Procianoy RS, Silveira RC. Prevalence of metabolic syndrome-like in the follow-up of very low birth weight preterm infants and associated factors. J Pediatr (Rio J) 2019; 95:291-297. [PMID: 29705050 DOI: 10.1016/j.jped.2018.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the prevalence of metabolic syndrome-like symptoms in a population of preterm infants with very low birth weight (<1500g) at 2 years of corrected age and identify the occurrence of associated risk factors. METHODS Cross-sectional study during a five-year period, including preterm infants born with very low birth weight evaluated at 2 years of corrected age. Metabolic syndrome-like symptoms was defined by the presence of three or more of these criteria: abdominal circumference≥90th percentile, fasting blood glucose≥100mg/dL, triglycerides≥110mg/dL, HDL cholesterol≤40mg/dL, and blood pressure≥90th percentile. RESULTS A total of 214 preterm infants with birth weight<1500g were evaluated. The prevalence of metabolic syndrome-like symptoms at 2 years of corrected age was 15.1%. Arterial hypertension was present in 57.5%, HDL≤40mg/dL in 29.2%, hypertriglyceridemia in 22.6%, and abdominal circumference above the 90th percentile in 18.8%. Only 3.7% had hyperglycemia. The presence of periventricular leukomalacia was an independent risk factor for arterial hypertension at this age (OR 2.34, 95% CI: 0.079-0.69, p=0.008). Overweight and obesity at 2 years of corrected age were independently associated with metabolic syndrome-like symptoms (OR 2.75, 95% CI: 1.19-6.36, p=0.018). CONCLUSION Metabolic syndrome-like symptoms can be observed in very low birth weight preterm infants as early as 2 years of corrected age. Overweight and early-onset obesity are significant risk factors for metabolic syndrome-like symptoms, which deserves appropriate intervention for this high-risk population.
Collapse
Affiliation(s)
- Luciana A Heidemann
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Renato S Procianoy
- Universidade Federal do Rio Grande do Sul (UFRGS), Serviço de Pediatria, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Serviço de Neonatologia, Porto Alegre, RS, Brazil
| | - Rita C Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Serviço de Pediatria, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Serviço de Neonatologia, Porto Alegre, RS, Brazil.
| |
Collapse
|
16
|
Heidemann LA, Procianoy RS, Silveira RC. Prevalence of metabolic syndrome-like at 2 years of corrected age in very low birth weight preterm infants and associated factors. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
17
|
Sullivan MC, Winchester SB, Msall ME. Prematurity and cardiovascular risk at early adulthood. Child Care Health Dev 2019; 45:71-78. [PMID: 30239014 PMCID: PMC6294665 DOI: 10.1111/cch.12616] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Theories of early stress exposure and allostatic load offer a lifespan perspective to adult health after prematurity based on these early stressors affecting endocrine and metabolic systems. In this study, we examine cardiovascular and metabolic risk by comparing two groups of preterm infants who experienced a full spectrum of neonatal illness and a term-born group at age 23. METHODS Of the 215 infants recruited at birth, 84% participated at age 23. The cohort included 45 full-term (FT), 24 healthy preterm (HPT), and 111 sick preterm (SPT) infants. Socio-economic status was equivalent across groups. Cardiovascular and metabolic outcomes were as follows: blood pressure (BP), fasting glucose and lipid profiles, weight, waist-hip ratio (WHR), and body mass index (BMI). Clinical and subclinical ranges were compared across neonatal groups and gender. RESULTS At age 23, the HPT and SPT groups had higher systolic BP compared with the FT group. The SPT group had lower weight compared with the FT and HPT groups. No group differences were found on diastolic BP, glucose, total cholesterol, high-density lipids, low-density lipids, triglycerides, BMI, or WHR. Preterm males had more systolic hypertension and low high-density lipids than FT males. Former preterm males and females had high WHR ratios and BMI at 23 years. Subclinical prehypertensive rates were highest for the HPT female group, followed by the SPT females. Only one (4.2%) HPT adult male was clinically diabetic. CONCLUSIONS As young adults, HPT and SPT infants had early indicators of cardiovascular risk but no indicators of metabolic risk. There is utility in using clinical and subclinical ranges to identify early cardiovascular risk in early adulthood.
Collapse
Affiliation(s)
- Mary C. Sullivan
- University of Rhode Island, College of Nursing, Providence, Rhode Island
| | | | - Michael E. Msall
- University of Chicago Comer Children’s Hospital, Section of Developmental & Behavioral Pediatrics, JP Kennedy Research Center on Intellectual and Developmental Disabilities, Chicago, IL
| |
Collapse
|
18
|
Mulkey SB, du Plessis AJ. Autonomic nervous system development and its impact on neuropsychiatric outcome. Pediatr Res 2019; 85:120-126. [PMID: 30166644 PMCID: PMC6353676 DOI: 10.1038/s41390-018-0155-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/22/2022]
Abstract
The central autonomic nervous system (ANS) is essential for maintaining cardiovascular and respiratory homeostasis in the newborn and has a critical role in supporting higher cortical functions. At birth, the central ANS is maturing and is vulnerable to adverse environmental and physiologic influences. Critical connections are formed early in development between the ANS and limbic system to integrate psychological and body responses. The Polyvagal Theory, developed by Stephen Porges, describes how modulation of the autonomic vagal impulse controls social responses and that a broad range of neuropsychiatric disorders may be due to impaired vagal balance, with either deficient vagal tone or excessive vagal reactivity. Under additional circumstances of prematurity, growth restriction, and environmental stress in the fetus and newborn, the immature ANS may undergo "dysmaturation". Maternal stress and health as well as the intrauterine environment are also quite important and have been implicated in causing ANS changes in the infant and neuropsychiatric diseases in children. This review will cover the aspects of ANS development and maturation that have been associated with neuropsychiatric disorders in children.
Collapse
Affiliation(s)
- Sarah B. Mulkey
- Assistant Professor, Department of Pediatrics and Neurology, George Washington University School of Medicine and Health Sciences, Fetal-Neonatal Neurologist, Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, District of Columbia
| | - Adre J. du Plessis
- Professor, Department of Pediatrics and Neurology, George Washington University School of Medicine and Health Sciences, Chief, Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, District of Columbia
| |
Collapse
|
19
|
The Critical Role of the Central Autonomic Nervous System in Fetal-Neonatal Transition. Semin Pediatr Neurol 2018; 28:29-37. [PMID: 30522725 PMCID: PMC6432941 DOI: 10.1016/j.spen.2018.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this article is to understand the complex role of the central autonomic nervous system in normal and complicated fetal-neonatal transition and how autonomic nervous system dysfunction can lead to brain injury. The central autonomic nervous system supports coordinated fetal transitional cardiovascular, respiratory, and endocrine responses to provide safe transition of the fetus at delivery. Fetal and maternal medical and environmental exposures can disrupt normal maturation of the autonomic nervous system in utero, cause dysfunction, and complicate fetal-neonatal transition. Brain injury may both be caused by autonomic nervous system failure and contribute directly to autonomic nervous system dysfunction in the fetus and newborn. The central autonomic nervous system has multiple roles in supporting transition of the fetus. Future studies should aim to improve real-time monitoring of fetal autonomic nervous system function and in supporting typical autonomic nervous system development even under complicated conditions.
Collapse
|
20
|
Morrison JL, Botting KJ, Darby JRT, David AL, Dyson RM, Gatford KL, Gray C, Herrera EA, Hirst JJ, Kim B, Kind KL, Krause BJ, Matthews SG, Palliser HK, Regnault TRH, Richardson BS, Sasaki A, Thompson LP, Berry MJ. Guinea pig models for translation of the developmental origins of health and disease hypothesis into the clinic. J Physiol 2018; 596:5535-5569. [PMID: 29633280 PMCID: PMC6265540 DOI: 10.1113/jp274948] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/19/2018] [Indexed: 12/12/2022] Open
Abstract
Over 30 years ago Professor David Barker first proposed the theory that events in early life could explain an individual's risk of non-communicable disease in later life: the developmental origins of health and disease (DOHaD) hypothesis. During the 1990s the validity of the DOHaD hypothesis was extensively tested in a number of human populations and the mechanisms underpinning it characterised in a range of experimental animal models. Over the past decade, researchers have sought to use this mechanistic understanding of DOHaD to develop therapeutic interventions during pregnancy and early life to improve adult health. A variety of animal models have been used to develop and evaluate interventions, each with strengths and limitations. It is becoming apparent that effective translational research requires that the animal paradigm selected mirrors the tempo of human fetal growth and development as closely as possible so that the effect of a perinatal insult and/or therapeutic intervention can be fully assessed. The guinea pig is one such animal model that over the past two decades has demonstrated itself to be a very useful platform for these important reproductive studies. This review highlights similarities in the in utero development between humans and guinea pigs, the strengths and limitations of the guinea pig as an experimental model of DOHaD and the guinea pig's potential to enhance clinical therapeutic innovation to improve human health.
Collapse
Affiliation(s)
- Janna L. Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health ResearchUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Kimberley J. Botting
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Jack R. T. Darby
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health ResearchUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Anna L. David
- Research Department of Maternal Fetal Medicine, Institute for Women's HealthUniversity College LondonLondonUK
| | - Rebecca M. Dyson
- Department of Paediatrics & Child Health and Centre for Translational PhysiologyUniversity of OtagoWellingtonNew Zealand
| | - Kathryn L. Gatford
- Robinson Research Institute and Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Clint Gray
- Department of Paediatrics & Child Health and Centre for Translational PhysiologyUniversity of OtagoWellingtonNew Zealand
| | - Emilio A. Herrera
- Pathophysiology Program, Biomedical Sciences Institute (ICBM), Faculty of MedicineUniversity of ChileSantiagoChile
| | - Jonathan J. Hirst
- Mothers and Babies Research Centre, Hunter Medical Research Institute, School of Biomedical Sciences and PharmacyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Bona Kim
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada
| | - Karen L. Kind
- School of Animal and Veterinary SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Bernardo J. Krause
- Division of Paediatrics, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | | | - Hannah K. Palliser
- Mothers and Babies Research Centre, Hunter Medical Research Institute, School of Biomedical Sciences and PharmacyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Timothy R. H. Regnault
- Departments of Obstetrics and Gynaecology, Physiology and PharmacologyWestern University, and Children's Health Research Institute and Lawson Health Research InstituteLondonOntarioCanada
| | - Bryan S. Richardson
- Departments of Obstetrics and Gynaecology, Physiology and PharmacologyWestern University, and Children's Health Research Institute and Lawson Health Research InstituteLondonOntarioCanada
| | - Aya Sasaki
- Department of PhysiologyUniversity of TorontoTorontoOntarioCanada
| | - Loren P. Thompson
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Mary J. Berry
- Department of Paediatrics & Child Health and Centre for Translational PhysiologyUniversity of OtagoWellingtonNew Zealand
| |
Collapse
|
21
|
Vohr BR, Heyne R, Bann C, Das A, Higgins RD, Hintz SR. High Blood Pressure at Early School Age Among Extreme Preterms. Pediatrics 2018; 142:peds.2018-0269. [PMID: 30054344 PMCID: PMC6317552 DOI: 10.1542/peds.2018-0269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Former preterm infants are at increased risk of hypertension with increasing age. Our objective was to identify rates of high blood pressure (BP) (≥90th percentile) and hypertension (BP ≥95th percentile) and associated risk factors among extreme preterm (EPT) infants at 6 to 7 years of age. METHODS Assessment included BP and anthropometrics. Comparisons were made by BP ≥90th versus <90th percentile. Regressions were run to identify relative risk (RR) of factors associated with BP ≥90th percentile. RESULTS Among 379 EPT infants, 20.6% had systolic high BP, 10.8% systolic hypertension, 21.4% diastolic high BP, and 11.4% diastolic hypertension. Children with systolic high BP had higher rates of BMI, triceps skinfolds >85th percentile, and waist circumference >90th percentile. In regression analyses, weight gain velocity from 18 months to school age (RR = 1.36), and maternal gestational diabetes (MGD) (RR = 2.04) predicted systolic and either systolic and/or diastolic high BP (RR = 1.27 and RR = 1.67). Among children with BMI <85th percentile, 17% had systolic and 19% had diastolic high BP. Regression analysis for normal weight children indicated public insurance (RR = 2.46) and MGD (RR = 2.16) predicted systolic high BP, and MGD (RR = 2.08) predicted either systolic or diastolic high BP. CONCLUSIONS Both overweight and normal weight EPT children are at risk for high BP and hypertension. Public insurance, MGD, and weight gain velocity are risk factors. Findings of high BP among EPT children at early school age are worrisome and indicate a need for close follow-up.
Collapse
Affiliation(s)
- Betty R. Vohr
- Division of Neonatal Medicine, Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Roy Heyne
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine,University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carla Bann
- Division of Statistical and Data Sciences, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Division of Biostatistics and Epidemiology, RTI International, Rockville, Maryland
| | - Rosemary D. Higgins
- Neonatal Research Network, National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; and
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Palo Alto, California
| | | | | |
Collapse
|
22
|
Crispi F, Miranda J, Gratacós E. Long-term cardiovascular consequences of fetal growth restriction: biology, clinical implications, and opportunities for prevention of adult disease. Am J Obstet Gynecol 2018; 218:S869-S879. [PMID: 29422215 DOI: 10.1016/j.ajog.2017.12.012] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
In the modern world, cardiovascular disease is a leading cause of death for both men and women. Epidemiologic studies consistently have suggested an association between low birthweight and/or fetal growth restriction and increased rate of cardiovascular mortality in adulthood. Furthermore, experimental and clinical studies have demonstrated that sustained nutrient and oxygen restriction that are associated with fetal growth restriction activate adaptive cardiovascular changes that might explain this association. Fetal growth restriction results in metabolic programming that may increase the risk of metabolic syndrome and, consequently, of cardiovascular morbidity in the adult. In addition, fetal growth restriction is strongly associated with fetal cardiac and arterial remodeling and a subclinical state of cardiovascular dysfunction. The cardiovascular effects ocurring in fetal life, includes cardiac morphology changes, subclinical myocardial dysfunction, arterial remodeling, and impaired endothelial function, persist into childhood and adolescence. Importantly, these changes have been described in all clinical presentations of fetal growth restriction, from severe early- to milder late-onset forms. In this review we summarize the current evidence on the cardiovascular effects of fetal growth restriction, from subcellular to organ structure and function as well as from fetal to early postnatal life. Future research needs to elucidate whether and how early life cardiovascular remodeling persists into adulthood and determines the increased cardiovascular mortality rate described in epidemiologic studies.
Collapse
|
23
|
Edstedt Bonamy AK, Mohlkert LA, Hallberg J, Liuba P, Fellman V, Domellöf M, Norman M. Blood Pressure in 6-Year-Old Children Born Extremely Preterm. J Am Heart Assoc 2017; 6:JAHA.117.005858. [PMID: 28765277 PMCID: PMC5586434 DOI: 10.1161/jaha.117.005858] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Advances in perinatal medicine have increased infant survival after very preterm birth. Although this progress is welcome, there is increasing concern that preterm birth is an emerging risk factor for hypertension at young age, with implications for the lifetime risk of cardiovascular disease. Methods and Results We measured casual blood pressures (BPs) in a population‐based cohort of 6‐year‐old survivors of extremely preterm birth (<27 gestational weeks; n=171) and in age‐ and sex‐matched controls born at term (n=172). Measured BP did not differ, but sex, age‐, and height‐adjusted median z scores were 0.14 SD higher (P=0.02) for systolic BP and 0.10 SD higher (P=0.01) for diastolic BP in children born extremely preterm than in controls. Among children born extremely preterm, shorter gestation, higher body mass index, and higher heart rate at follow‐up were all independently associated with higher BP at 6 years of age, whereas preeclampsia, smoking in pregnancy, neonatal morbidity, and perinatal corticosteroid therapy were not. In multivariate regression analyses, systolic BP decreased by 0.10 SD (P=0.08) and diastolic BP by 0.09 SD (P=0.02) for each week‐longer gestation. Conclusions Six‐year‐old children born extremely preterm have normal but slightly higher BP than their peers born at term. Although this finding is reassuring for children born preterm and their families, follow‐up at older age is warranted.
Collapse
Affiliation(s)
- Anna-Karin Edstedt Bonamy
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden .,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Lilly-Ann Mohlkert
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jenny Hallberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Petru Liuba
- Department of Pediatric Cardiology, Lund University, Lund, Sweden.,Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Vineta Fellman
- Department of Pediatrics & Clinical Science, Skåne University Hospital and Lund University, Lund, Sweden.,Children's Hospital, Clinicum, Helsinki University Hospital and University of Helsinki, Finland
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
24
|
Vashishta N, Surapaneni V, Chawla S, Kapur G, Natarajan G. Association among prematurity (<30 weeks' gestational age), blood pressure, urinary albumin, calcium, and phosphate in early childhood. Pediatr Nephrol 2017; 32:1243-1250. [PMID: 28391546 DOI: 10.1007/s00467-017-3581-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a paucity of data on blood pressures (BP), urinary albumin, and mineral excretion in early childhood in contemporary cohorts of extremely low gestational age (GA) neonates. Our aim was to compare BPs and the urinary excretion of albumin, calcium, and phosphate in preterm and term-born cohorts in early childhood. METHODS This was a prospective observational study conducted at a single center, involving children <5 years age, born preterm (GA <30 weeks) or at term (≥37 weeks' GA). Urinary albumin (mg/L), calcium and phosphate levels indexed to creatinine (mg/dL), and BP were measured. RESULTS The median (IQR) follow-up age of our cohort (n = 106) was 30 (16-48) months. Preterm-born children (n = 55) had a significantly lower mean GA and birth weight and higher mean systolic, diastolic, and mean BPs, compared with term (n = 51) controls. A significantly higher proportion of preterm-born children weighed <10th centile and had systolic BP >95th centile at follow-up. Albumin and calcium excretion did not differ between the groups; median urine-phosphate creatinine ratios were higher in the preterm group. On logistic regression, lower GA and younger age at follow-up were significantly associated with an increased risk of systolic and diastolic BP above the 95th centile; male gender was associated with decreased risk of diastolic hypertension. CONCLUSIONS Even in early childhood, children born preterm had significantly elevated BP, compared with their term-born counterparts. Closer monitoring of BPs in this population may be warranted.
Collapse
Affiliation(s)
- Namrata Vashishta
- Division of Neonatology, Wayne State University, Detroit, MI, USA.,St. John Providence Hospital, Southfield, MI, USA
| | - Vidya Surapaneni
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sanjay Chawla
- Division of Neonatology, Wayne State University, Detroit, MI, USA
| | - Gaurav Kapur
- Division of Pediatric Nephrology, Wayne State University, Detroit, MI, USA
| | - Girija Natarajan
- Division of Neonatology, Wayne State University, Detroit, MI, USA. .,Division of Neonatology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
| |
Collapse
|
25
|
Kaczmarczyk K, Wiszomirska I, Szturmowicz M, Magiera A, Błażkiewicz M. Are preterm-born survivors at risk of long-term respiratory disease? Ther Adv Respir Dis 2017; 11:277-287. [PMID: 28614994 PMCID: PMC5933633 DOI: 10.1177/1753465817710595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To evaluate the long-term impact of preterm birth on respiratory function in female patients born preterm, we undertook spirometric examinations twice, as they reached the age of puberty, then follow-up examinations of part of the same cohort in adulthood. We sought evidence that preterm birth is correlated with poorer spirometric results into adulthood. METHODS A total of 70 girls (aged 12.2 ± 1.5 years in 1997) who had been born preterm (at 34.7 ± 1.86 weeks, none having experienced bronchopulmonary dysplasia) took part in spriometric examinations in 1997 and again in 1998. Of those, after a gap of 17 years, a group of 12 were successfully recontacted and participated in the 2015 examination as adults (then aged 27.6 ± 2.6 years, born at 34.5 ± 1.92 weeks). We compared spirometric results across the adolescent and adult examinations, and compared the adult results with an adult reference group. RESULTS The percentage values of FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity) and MVV (maximal voluntary ventilation) showed significant improvement between the two examinations in the early adolescent period. In adulthood, FEV1%pred (percentage predicted forced expiratory volume in 1 s) showed no statistically significant difference. The mean values of both FVC and FVC%pred (percentage predicted forced vital capacity) for the preterm-born group were lower than for the reference group, but this was not statistically significant. The preterm-born group showed lower values of such parameters as forced expiratory flow at 25-75% of FVC, MEF25 (maximal expiratory flow at 25% of forced vital capacity) and FEV1/FVC as compared with the reference group, but again without statistical significance. CONCLUSIONS (1) A somewhat below-norm level of respiratory parameters among preterm-born girls entering pubescence may attest to continued negative impact on their respiratory system. (2) A significant improvement in their spirometric results 1 year later may indicate that pubescence helps compensate for the earlier negative effect of preterm birth. (3) No significant differences were seen in lung function in preterm-born adults as compared with a reference group of adults, although the preterm-born group did exhibit lower values of all parameters studied and more frequent obstructive disorders.
Collapse
Affiliation(s)
- Katarzyna Kaczmarczyk
- Head of Physiology Department, Faculty of
Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw,
Marymoncka 34 Street, Warsaw, Poland
| | - Ida Wiszomirska
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Magdalena Szturmowicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Andrzej Magiera
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| | - Michalina Błażkiewicz
- Józef Piłsudski University of Physical Education
in Warsaw, Faculty of Rehabilitation, Warsaw, Poland
| |
Collapse
|
26
|
Pyhälä R, Wolford E, Kautiainen H, Andersson S, Bartmann P, Baumann N, Brubakk AM, Evensen KAI, Hovi P, Kajantie E, Lahti M, Van Lieshout RJ, Saigal S, Schmidt LA, Indredavik MS, Wolke D, Räikkönen K. Self-Reported Mental Health Problems Among Adults Born Preterm: A Meta-analysis. Pediatrics 2017; 139:peds.2016-2690. [PMID: 28283612 DOI: 10.1542/peds.2016-2690] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Preterm birth increases the risk for mental disorders in adulthood, yet findings on self-reported or subclinical mental health problems are mixed. OBJECTIVE To study self-reported mental health problems among adults born preterm at very low birth weight (VLBW; ≤1500 g) compared with term controls in an individual participant data meta-analysis. DATA SOURCES Adults Born Preterm International Collaboration. STUDY SELECTION Studies that compared self-reported mental health problems using the Achenbach Young Adult Self Report or Adult Self Report between adults born preterm at VLBW (n = 747) and at term (n = 1512). DATA EXTRACTION We obtained individual participant data from 6 study cohorts and compared preterm and control groups by mixed random coefficient linear and Tobit regression. RESULTS Adults born preterm reported more internalizing (pooled β = .06; 95% confidence interval .01 to .11) and avoidant personality problems (.11; .05 to .17), and less externalizing (-.10; -.15 to -.06), rule breaking (-.10; -.15 to -.05), intrusive behavior (-.14; -.19 to -.09), and antisocial personality problems (-.09; -.14 to -.04) than controls. Group differences did not systematically vary by sex, intrauterine growth pattern, neurosensory impairments, or study cohort. LIMITATIONS Exclusively self-reported data are not confirmed by alternative data sources. CONCLUSIONS Self-reports of adults born preterm at VLBW reveal a heightened risk for internalizing problems and socially avoidant personality traits together with a lowered risk for externalizing problem types. Our findings support the view that preterm birth constitutes an early vulnerability factor with long-term consequences on the individual into adulthood.
Collapse
Affiliation(s)
- Riikka Pyhälä
- Department of Psychology and Logopedics, and .,Folkhälsan Research Centre, Helsinki, Finland
| | | | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Sture Andersson
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Bonn, Germany
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Ann-Mari Brubakk
- Department of Laboratory Medicine, Children's and Women's Health
| | - Kari Anne I Evensen
- Department of Laboratory Medicine, Children's and Women's Health.,Department of Public Health and General Practice, and
| | - Petteri Hovi
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Eero Kajantie
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,National Institute for Health and Welfare, Oulu, Finland.,PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marius Lahti
- Department of Psychology and Logopedics, and.,University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Louis A Schmidt
- National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology, Neuroscience & Behavior, McMaster University, Hamilton, Ontario, Canada
| | - Marit S Indredavik
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim University Hospital, Norway; and
| | - Dieter Wolke
- Department of Neonatology, University Hospital Bonn, Bonn, Germany.,Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | |
Collapse
|
27
|
Abstract
Pregnancy complications, such as hypertensive disorders or preterm delivery, identify families predisposed to cardiovascular problems at other times in life. Whether the pregnancy complication induces cardiac disease or whether the pregnancy stress unmasks an underlying predisposition remains unclear. However, improved survival following severe pregnancy complications for both the mother and, in particular, the offspring - who is often born preterm - has resulted in a growing cohort of individuals who carry this increased cardiovascular risk. Research to understand the underlying pathological mechanisms that link these conditions might ultimately lead to novel therapeutic or prevention strategies for both cardiovascular and pregnancy disease.
Collapse
Affiliation(s)
- Christina Y Aye
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK
| |
Collapse
|
28
|
Hovi P, Vohr B, Ment LR, Doyle LW, McGarvey L, Morrison KM, Evensen KAI, van der Pal S, Grunau RE, Brubakk AM, Andersson S, Saigal S, Kajantie E. Blood Pressure in Young Adults Born at Very Low Birth Weight: Adults Born Preterm International Collaboration. Hypertension 2016; 68:880-7. [PMID: 27572149 DOI: 10.1161/hypertensionaha.116.08167] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 11/16/2022]
Abstract
Adults born preterm at very low birth weight (VLBW; <1500 g) have higher blood pressure than those born at term. It is not known whether all VLBW adults are at risk or whether higher blood pressure could be attributed to some of the specific conditions underlying or accompanying preterm birth. To identify possible risk or protective factors, we combined individual-level data from 9 cohorts that measured blood pressure in young adults born at VLBW or with a more stringent birth weight criterion. In the absence of major heterogeneity, we performed linear regression analysis in our pooled sample of 1571 adults born at VLBW and 777 controls. Adults born at VLBW had 3.4 mm Hg (95% confidence interval, 2.2-4.6) higher systolic and 2.1 mm Hg (95% confidence interval, 1.3-3.0) higher diastolic pressure, with adjustment for age, sex, and cohort. The difference in systolic pressure was present in men (1.8 mm Hg; 95% confidence interval, 0.1-3.5) but was stronger in women (4.7 mm Hg; 95% confidence interval, 3.2-6.3). Among the VLBW group, blood pressure was unrelated to gestational age, maternal smoking, multiple pregnancy, retinopathy of prematurity, or bronchopulmonary dysplasia. Blood pressure was higher than that of controls among VLBW adults unexposed to maternal preeclampsia. Among those exposed, it was even higher, especially if born appropriate for gestational age. In conclusion, although female sex and maternal preeclampsia are additional risk factors, the risk of higher blood pressure is not limited to any etiologic subgroup of VLBW adults, arguing for vigilance in early detection of high blood pressure in all these individuals.
Collapse
Affiliation(s)
- Petteri Hovi
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.).
| | - Betty Vohr
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Laura R Ment
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Lex W Doyle
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Lorcan McGarvey
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Katherine M Morrison
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Kari Anne I Evensen
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Sylvia van der Pal
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Ruth E Grunau
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | | | - Ann-Mari Brubakk
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Sture Andersson
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Saroj Saigal
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| | - Eero Kajantie
- From the Chronic Disease Prevention Unit, Department of Health, National Institute for Health and Welfare, Helsinki, Finland (P.H., E.K.); Department of Pediatrics, Helsinki University Central Hospital and University of Helsinki, Finland (P.H., S.A., E.K.); Department of Pediatrics, Women and Infants Hospital, Providence, RI (B.V., L.R.M.); Royal Women's Hospital, Melbourne, Australia (L.W.D.); Department of Obstetrics and Gynaecology, The University of Melbourne, Australia (L.W.D.); Department of Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia (L.W.D.); Respiratory Medicine Centre for Infection and Immunity, The Queen's University of Belfast, Northern Ireland (L.M.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (K.M.M., S.S.); Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim (K.A.I.E., A.-M.B.); Department of Child Health, TNO, Leiden, The Netherlands (S.v.d.P.); Department of Pediatrics, University of British Columbia, Vancouver, Canada (R.E.G.); and PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Finland (E.K.)
| |
Collapse
|
29
|
The dynamics of cardiac autonomic control in sleeping preterm neonates exposed in utero to smoking. Clin Neurophysiol 2016; 127:2871-2877. [DOI: 10.1016/j.clinph.2016.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/23/2016] [Accepted: 05/01/2016] [Indexed: 11/18/2022]
|
30
|
Watkins WJ, Kotecha SJ, Kotecha S. All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales. PLoS Med 2016; 13:e1002018. [PMID: 27163787 PMCID: PMC4862683 DOI: 10.1371/journal.pmed.1002018] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 03/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low birthweight (LBW) is associated with increased mortality in infancy, but its association with mortality in later childhood and adolescence is less clear. We investigated the association between birthweight and all-cause mortality and identified major causes of mortality for different birthweight groups. METHODS AND FINDINGS We conducted a population study of all live births occurring in England and Wales between 1 January 1993 and 31 December 2011. Following exclusions, the 12,355,251 live births were classified by birthweight: 500-1,499 g (very LBW [VLBW], n = 139,608), 1,500-2,499 g (LBW, n = 759,283), 2,500-3,499 g (n = 6,511,411), and ≥3,500 g (n = 4,944,949). The association of birthweight group with mortality in infancy (<1 y of age) and childhood/adolescence (1-18 y of age) was quantified, with and without covariates, through hazard ratios using Cox regression. International Classification of Diseases codes identified causes of death. In all, 74,890 (0.61%) individuals died between birth and 18 y of age, with 23% of deaths occurring after infancy. Adjusted hazard ratios for infant deaths were 145 (95% CI 141, 149) and 9.8 (95% CI 9.5, 10.1) for the VLBW and LBW groups, respectively, compared to the ≥3,500 g group. The respective hazard ratios for death occurring at age 1-18 y were 6.6 (95% CI 6.1, 7.1) and 2.9 (95% CI 2.8, 3.1). Male gender, the youngest and oldest maternal age bands, multiple births, and deprivation (Index of Multiple Deprivation score) also contributed to increased deaths in the VLBW and LBW groups in both age ranges. In infancy, perinatal factors, particularly respiratory issues and infections, explained 84% and 31% of deaths in the VLBW and LBW groups, respectively; congenital malformations explained 36% and 23% in the LBW group and ≥2,500 g groups (2,500-3,499 g and ≥3,500 g groups combined), respectively. Central nervous system conditions explained 20% of deaths in childhood/adolescence in the VLBW group, with deaths from neoplasms and external conditions increasingly prevalent in the 1,500-2,499 g and ≥2,500 g birthweight groups. The study would have benefited had we had access to information on gestational age and maternal smoking, but since the former is highly correlated with birthweight and the latter with deprivation, we believe that our findings remain robust despite these shortcomings. CONCLUSIONS LBW is associated with infant and later child and adolescent mortality, with perinatal factors and congenital malformations explaining many of the deaths. By understanding and ameliorating the influences of upstream exposures such as maternal smoking and deprivation, later mortality can be decreased by reducing the delivery of vulnerable infants with LBW.
Collapse
Affiliation(s)
- W. John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah J. Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
- * E-mail:
| |
Collapse
|
31
|
Steen E, Bonamy AK, Norman M, Hellström-Westas L. Preterm birth may be a larger risk factor for increased blood pressure than intrauterine growth restriction. Acta Paediatr 2015; 104:1098-103. [PMID: 26094552 DOI: 10.1111/apa.13095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 02/02/2015] [Accepted: 06/16/2015] [Indexed: 01/04/2023]
Abstract
AIM Very low birthweight (VLBW) and prematurity have been associated with an increased risk of high blood pressure (BP). We compared BP and salivary cortisol responses to a stressful situation between adolescents with a VLBW and controls. METHODS We compared three groups aged 12-17 years: 30 born VLBW but appropriate for gestational age (AGA) at a mean of 27 weeks, 19 born VLBW but small for gestational age (SGA) at a mean of 31 weeks and 43 term-born AGA controls. Three consecutive BP measurements were performed before a magnetic resonance imaging (MRI) examination. Salivary cortisol and perceived stress were assessed before and after the MRI. RESULTS Systolic and diastolic BP decreased significantly for each repeated measurement in the VLBW-SGA group and controls, but remained unchanged in the VLBW-AGA group. The third systolic BP measurement was 9-12 mmHg higher in the VLBW-AGA group than the other groups (p < 0.05). There were no differences in salivary cortisol between the groups, before and after the MRI or between the sexes. CONCLUSION Dynamic BP responses differed between adolescents born VLBW-AGA and the other groups, indicating that extremely preterm birth may be a larger risk factor for increased BP than intrauterine growth restriction.
Collapse
Affiliation(s)
- Emma Steen
- Department of Clinical Sciences; Lund University; Lund Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
| | - Anna-Karin Bonamy
- Department of Women's and Children's Health; Karolinska Institutet Stockholm; Stockholm Sweden
| | - Mikael Norman
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet Stockholm; Stockholm Sweden
| | - Lena Hellström-Westas
- Department of Clinical Sciences; Lund University; Lund Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW Eleven percent of infants are born preterm worldwide. Preterm infants continue their development and growth in a substantially different environment than in uterus. The prenatal and postnatal period have long-lasting effects on a child's health. Previous studies have shown that adults born preterm with very low birth weight show enhancement of cardiometabolic risk factors such as elevated blood pressure and impaired glucose regulation compared with their peers born at term. RECENT FINDINGS Recent studies have more often included individuals born less preterm, as over 70% of premature infants are born late preterm (in 34-36 gestational weeks). Adults born preterm have elevated levels of cardiometabolic-risk factors concerning several aspects such as body size and composition, energy metabolism, blood pressure, vascular structure, glucose and lipid metabolism, lifestyle, and some emerging cardiometabolic-risk factors. SUMMARY Most of the cardiometabolic-risk factors related to preterm birth are modifiable. Favorable early-life circumstances of premature infants, such as optimal nutrition and growth, might reduce the risk of later cardiometabolic disorders. In addition, adults born preterm might particularly benefit from screening of risk factors and promotion of a healthy lifestyle.
Collapse
Affiliation(s)
- Marika Sipola-Leppänen
- aChronic Disease Prevention Unit, National Institute for Health and Welfare, Oulu bChronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki cDepartment of Pediatrics and Adolescence, PEDEGO, Oulu University Hospital, Oulu dInstitute of Health Science, University of Oulu eChildren's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki fDepartment of Obstetrics and Gynecology, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | |
Collapse
|
33
|
Ramani M, Bradley WE, Dell'Italia LJ, Ambalavanan N. Early exposure to hyperoxia or hypoxia adversely impacts cardiopulmonary development. Am J Respir Cell Mol Biol 2015; 52:594-602. [PMID: 25255042 DOI: 10.1165/rcmb.2013-0491oc] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Preterm infants are at high risk for long-term abnormalities in cardiopulmonary function. Our objectives were to determine the long-term effects of hypoxia or hyperoxia on cardiopulmonary development and function in an immature animal model. Newborn C57BL/6 mice were exposed to air, hypoxia (12% oxygen), or hyperoxia (85% oxygen) from Postnatal Day 2-14, and then returned to air for 10 weeks (n = 2 litters per condition; > 10/group). Echocardiography, blood pressure, lung function, and lung development were evaluated at 12-14 weeks of age. Lungs from hyperoxia- or hypoxia-exposed mice were larger and more compliant (compliance: air, 0.034 ± 0.001 ml/cm H2O; hypoxia, 0.049 ± 0.002 ml/cm H2O; hyperoxia, 0.053 ± 0.002 ml/cm H2O; P < 0.001 air versus others). Increased airway reactivity, reduced bronchial M2 receptor staining, and increased bronchial α-smooth muscle actin content were noted in hyperoxia-exposed mice (maximal total lung resistance with methacholine: air, 1.89 ± 0.17 cm H2O ⋅ s/ml; hypoxia, 1.52 ± 0.34 cm H2O ⋅ s/ml; hyperoxia, 4.19 ± 0.77 cm H2O ⋅ s/ml; P < 0.004 air versus hyperoxia). Hyperoxia- or hypoxia-exposed mice had larger and fewer alveoli (mean linear intercept: air, 40.2 ± 0. 0.8 μm; hypoxia, 76.4 ± 2.4 μm; hyperoxia, 95.6 ± 4.6 μm; P < 0.001 air versus others; radial alveolar count [n]: air, 11.1 ± 0.4; hypoxia, 5.7 ± 0.3; hyperoxia, 5.6 ± 0.3; P < 0.001 air versus others). Hyperoxia-exposed adult mice had left ventricular dysfunction without systemic hypertension. In conclusion, exposure of newborn mice to hyperoxia or hypoxia leads to cardiopulmonary abnormalities in adult life, similar to that described in ex-preterm infants. This animal model may help to identify underlying mechanisms and to develop therapeutic strategies for pulmonary morbidity in former preterm infants.
Collapse
|
34
|
Sipola-Leppänen M, Vääräsmäki M, Tikanmäki M, Matinolli HM, Miettola S, Hovi P, Wehkalampi K, Ruokonen A, Sundvall J, Pouta A, Eriksson JG, Järvelin MR, Kajantie E. Cardiometabolic risk factors in young adults who were born preterm. Am J Epidemiol 2015; 181:861-73. [PMID: 25947956 PMCID: PMC4445394 DOI: 10.1093/aje/kwu443] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/09/2014] [Indexed: 11/16/2022] Open
Abstract
Adults who were born preterm with a very low birth weight have higher blood pressure and impaired glucose regulation later in life compared with those born at term. We investigated cardiometabolic risk factors in young adults who were born at any degree of prematurity in the Preterm Birth and Early Life Programming of Adult Health and Disease (ESTER) Study, a population-based cohort study of individuals born in 1985–1989 in Northern Finland. In 2009–2011, 3 groups underwent clinical examination: 134 participants born at less than 34 gestational weeks (early preterm), 242 born at 34–36 weeks (late preterm), and 344 born at 37 weeks or later (controls). Compared with controls, adults who were born preterm had higher body fat percentages (after adjustment for sex, age, and cohort (1985–1986 or 1987–1989), for those born early preterm, difference = 6.2%, 95% confidence interval (CI): 0.4, 13.2; for those born late preterm, difference = 8.0%, 95% CI: 2.4, 13.8), waist circumferences, blood pressure (for those born early preterm, difference = 3.0 mm Hg, 95% CI: 0.9, 5.1; for those born late preterm, difference = 1.7, 95% CI: −0.1, 3.4), plasma uric acid levels (for those born early preterm, difference = 20.1%, 95% CI: 7.9, 32.3; for those born late preterm, difference = 20.2%, 95% CI: 10.7, 30.5), alanine aminotransferase levels, and aspartate transaminase levels. They were also more likely to have metabolic syndrome (for those born early preterm, odds ratio = 3.7, 95% CI: 1.6, 8.2; for those born late preterm, odds ratio = 2.5, 95% CI: 1.2, 5.3). Elevated levels of conventional and emerging risk factors suggest a higher risk of cardiometabolic disease later in life. These risk factors are also present in the large group of adults born late preterm.
Collapse
Affiliation(s)
- Marika Sipola-Leppänen
- Correspondence to Dr. Marika Sipola-Leppänen, National Institute for Health and Welfare, P.O. Box 310, 90101 Oulu, Finland (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Kaseva N, Martikainen S, Tammelin T, Hovi P, Järvenpää AL, Andersson S, Eriksson JG, Räikkönen K, Pesonen AK, Wehkalampi K, Kajantie E. Objectively measured physical activity in young adults born preterm at very low birth weight. J Pediatr 2015; 166:474-6. [PMID: 25454929 DOI: 10.1016/j.jpeds.2014.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/15/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
Unimpaired adults born preterm at very low birth weight (<1500 g) consistently have lower conditioning physical activity than those born at term. We used wrist-worn accelerometers to measure objectively physical activity in 57 very low birth weight and 47 control subjects aged 25 years. We found no difference in any physical activity measures.
Collapse
Affiliation(s)
- Nina Kaseva
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
| | - Silja Martikainen
- Department of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | - Tuija Tammelin
- LIKES Research Center for Sport and Health Sciences, Jyväskylä, Finland
| | - Petteri Hovi
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Anna-Liisa Järvenpää
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Sture Andersson
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Johan G Eriksson
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland; Vasa Central Hospital, Vasa, Finland; Folkhälsan Research Centre, Helsinki, Finland
| | - Katri Räikkönen
- Department of Behavioral Sciences, University of Helsinki, Helsinki, Finland
| | | | - Karoliina Wehkalampi
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Diabetes Prevention Unit, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| |
Collapse
|
36
|
Sipola-Leppänen M, Karvonen R, Tikanmäki M, Matinolli HM, Martikainen S, Pesonen AK, Räikkönen K, Järvelin MR, Hovi P, Eriksson JG, Vääräsmäki M, Kajantie E. Ambulatory blood pressure and its variability in adults born preterm. Hypertension 2015; 65:615-21. [PMID: 25601930 DOI: 10.1161/hypertensionaha.114.04717] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adults born preterm have higher blood pressure (BP) than those born at term. Most studies have focused on preterm birth, and few have assessed BP variability, an independent risk factor of cardiovascular disease. We studied the association of preterm birth with 24-hour ambulatory BP, measured by an oscillometric device, in 42 young adults born early preterm (<34 weeks), 72 born late preterm (34-36 weeks), and 103 controls (≥37 weeks). Sleep was confirmed with accelerometry in 72.4% of subjects. The 24-hour systolic BP of adults born early preterm was 5.5 mm Hg higher (95% confidence interval, 1.9-9.3), awake systolic BP was 6.4 mm Hg higher (95% confidence interval, 2.8-10.1), and sleeping systolic BP was 2.9 mm Hg higher (95% confidence interval 0.3-7.5) when adjusted for age, sex, and use of accelerometry. The differences remained similar when adjusted for height, body mass index, physical activity, smoking, parental education, maternal body mass index, smoking during pregnancy, and gestational diabetes mellitus and attenuated slightly when adjusted for maternal hypertensive pregnancy disorders. Adults born early preterm also had higher BP variability as indicated by higher individual standard deviations of systolic BP and diastolic BP. Although our results were consistent with a dose-response relationship between shorter gestation and higher BP, the difference between the late preterm and term groups was not statistically significant. Our results suggest that the higher BP in adults born early preterm is present during both waking and sleeping hours, may be more pronounced during waking hours, and is accompanied by higher individual BP variability.
Collapse
Affiliation(s)
- Marika Sipola-Leppänen
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.).
| | - Risto Karvonen
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Marjaana Tikanmäki
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Hanna-Maria Matinolli
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Silja Martikainen
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Anu-Katriina Pesonen
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Katri Räikkönen
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Marjo-Riitta Järvelin
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Petteri Hovi
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Johan G Eriksson
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Marja Vääräsmäki
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| | - Eero Kajantie
- From the Departments of Chronic Disease Prevention (M.S.-L., R.K., M.T., H.-M.M., P.H., J.G.E., E.K.) and Children and Families (M.-R.J., M.V.), National Institute for Health and Welfare, Oulu and Helsinki, Finland; Institute of Health Sciences (M.S.-L., M.T., M.-R.J.) and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital (M.V., E.K.), University of Oulu, Oulu, Finland; Biocenter Oulu, Oulu, Finland (M.-R.J.); Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland (M.S.-L.); Unit of Primary Care, Oulu, Finland (M.R.J.); Institute of Behavioural Sciences (S.M., A.-K.P., K.R.) and Children's Hospital, Helsinki University Central Hospital (P.H., E.K.), University of Helsinki, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland (J.G.E.); Department of Epidemiology and Biostatistics, Imperial College London, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, London, United Kingdom (M.-R.J.); and Folkhälsan Research Center, Helsinki, Finland (J.G.E.)
| |
Collapse
|
37
|
de Jong M, Lafeber HN, Cranendonk A, van Weissenbruch MM. Components of the metabolic syndrome in early childhood in very-low-birth-weight infants. Horm Res Paediatr 2015; 81:43-9. [PMID: 24281139 DOI: 10.1159/000355597] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Term small-for-gestational-age and preterm born infants have an increased prevalence of metabolic syndrome components already in childhood. Data in very-low-birth-weight (VLBW) children are limited. We investigated the prevalence of metabolic syndrome components in VLBW infants at 2 years of corrected age. METHODS We included 38 children, participating in the Neonatal Insulin Replacement Therapy in Europe (NIRTURE) trial, a randomized controlled trial of early insulin therapy in VLBW infants. Metabolic syndrome components were defined as: body mass index SDS >2; blood pressure (systolic and/or diastolic) ≥ 90th percentile; triglycerides ≥ 0.98 mmol/l; high-density lipoprotein (HDL) cholesterol ≤ 1.03 mmol/l; glucose ≥ 5.6 mmol/l. RESULTS Two children (5%) had three metabolic syndrome components, 13 children (34%) had two components, and 11 children (29%) one component. 63% had raised blood pressure (prevalence higher in boys), 32% low HDL, and 30% high triglycerides (prevalence lower in early insulin group). In children with body mass index SDS <0, insulin-treated children had higher HDL than children with standard care. Systolic blood pressure was correlated with growth between term and 2 years of corrected age. CONCLUSIONS VLBW infants already have a high prevalence of metabolic syndrome components at 2 years of corrected age. Early insulin treatment could have long-term benefits for some of these components.
Collapse
Affiliation(s)
- Miranda de Jong
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | |
Collapse
|
38
|
Lee H, Dichtl S, Mormanova Z, Dalla Pozza R, Genzel-Boroviczeny O. In adolescence, extreme prematurity is associated with significant changes in the microvasculature, elevated blood pressure and increased carotid intima-media thickness. Arch Dis Child 2014; 99:907-11. [PMID: 24879769 DOI: 10.1136/archdischild-2013-304074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Increased carotid intima-media thickness (cIMT) and loss of capillary density are antecedents of cardiovascular disease in adults. Former preterm infants are at risk for metabolic precursors of vascular disease, but vascular changes have not yet been studied in this population. PATIENTS AND METHODS In 54 former preterm (birth weigh (BW) 753±152 g) and 12 term children (BW 3395±558 g), functional vessel density (FVD) on the forearm and cIMT were obtained at a mean (±SD) age of 11.8±1.5 years. FVD was measured using sidestream dark field imaging before, during and after arterial occlusion, and cIMT using high resolution B-mode ultrasonography. Statistical comparisons were made using the t test, Mann-Whitney U test and the sign test for symmetry, with a two-sided p value as appropriate. RESULTS The systolic blood pressure of the former preterm children was significantly increased compared to reference values (females 119±8, z score 1.23; males 118±11, z score 1.14 mm Hg), as were the cIMT values (0.45±0.03 mm vs 0.38±0.04 mm; p<0.001). FVD was significantly higher in former preterm children compared to controls at baseline (mean±SD 33.6±14.5 cm/cm(2) vs 23.0±7.1 cm/cm(2); p=0.002) with decreased reactivity during arterial occlusion (χ(2) 7.14, p=0.008). CONCLUSIONS Preterm birth is associated with significant permanent alteration in the microcirculation and increased cIMT and systolic blood pressure. It is unknown whether these changes are due to preterm birth and rapid maturation of the skin or to nutritional factors, as previously thought. This is an important area of future research.
Collapse
Affiliation(s)
- HaNa Lee
- Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Sabrina Dichtl
- Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Zuzanna Mormanova
- Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Orsolya Genzel-Boroviczeny
- Division of Neonatology IS, Hauner Dr. von Hauner Children's Hospital, University of Munich, Munich, Germany
| |
Collapse
|
39
|
Sipola-Leppänen M, Vääräsmäki M, Tikanmäki M, Hovi P, Miettola S, Ruokonen A, Pouta A, Järvelin MR, Kajantie E. Cardiovascular risk factors in adolescents born preterm. Pediatrics 2014; 134:e1072-81. [PMID: 25180275 DOI: 10.1542/peds.2013-4186] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescents and adults born as small preterm infants show more pronounced risk factors of cardiovascular disease. Whether similar risks apply across all degrees of preterm birth is poorly known. METHODS We studied the association between preterm birth and cardiovascular risk factors in 6642 16-year-old adolescents of the population-based Northern Finland Birth Cohort 1986. Of these, 79 (1.2%) were born at <34 gestational weeks (early preterm), 238 (3.6%) at 34 to 36 weeks (late preterm), and 6325 at term (controls). RESULTS Girls born early preterm had 6.7 mm Hg (95% confidence interval: 3.1-10.2) higher systolic blood pressure (BP) and 3.5 mm Hg (1.1-5.8) higher diastolic BP, but no difference in serum lipid levels compared with control girls. Boys showed no differences in BP, but boys born early preterm had 6.7% (0.2%-13.7%) higher total cholesterol, 11.7% (2.1%-22.3%) higher low-density lipoprotein cholesterol, and 12.3% (3.1%-22.4%) higher apolipoprotein B concentrations. The differences were similar (BP) or stronger (lipids) when adjusted for maternal smoking, birth weight SD score, parental education, pubertal stage, BMI, and lifestyle. There were similar associations with length of gestation as a continuous variable. Accordingly, mean differences between late preterm and controls were in the same direction but weaker, although most were not statistically significant. CONCLUSIONS Preterm birth was associated with elevated BP in adolescent girls and an atherogenic lipid profile in boys. Because these associations were strongest among those born early preterm, our findings are consistent with a dose-response relationship between shorter length of gestation and cardiovascular risk factors.
Collapse
Affiliation(s)
- Marika Sipola-Leppänen
- Departments of Chronic Disease Prevention, Diabetes Prevention Unit and Institute of Health Sciences, and Department of Pediatrics and Adolescence,
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland
| | - Marjaana Tikanmäki
- Departments of Chronic Disease Prevention, Diabetes Prevention Unit and Institute of Health Sciences, and
| | - Petteri Hovi
- Departments of Chronic Disease Prevention, Diabetes Prevention Unit and Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland; and
| | - Satu Miettola
- Departments of Chronic Disease Prevention, Diabetes Prevention Unit and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aimo Ruokonen
- NordLab Oulu, Oulu University Hospital, Oulu, Finland; Department of Clinical Chemistry
| | - Anneli Pouta
- Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Institute of Health Sciences, and Children, Young People and Families, National Institute for Health and Welfare, Oulu, Finland; Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom Biocenter Oulu, University of Oulu, Oulu, Finland; Unit of Primary Care, and
| | - Eero Kajantie
- Departments of Chronic Disease Prevention, Diabetes Prevention Unit and Department of Obstetrics and Gynecology, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland; and
| |
Collapse
|
40
|
|
41
|
Effects of breastfeeding on the risk factors for metabolic syndrome in preterm infants. J Dev Orig Health Dis 2014; 5:459-64. [DOI: 10.1017/s2040174414000397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Evidence suggests that breastfeeding during infancy lowers the risk of metabolic syndrome (MS) and its attendant risk factors in adult life. To investigate the influence of feeding type on the risk factors of MS, we assessed insulin sensitivity and lipid and apolipoprotein metabolism in preterm infants. Blood samples were collected from preterm infants at the time of discharge. Infants were separated into two groups: a breast milk (BM) group receiving ⩾90% of their intake from BM, and a mixed-fed (MF) group receiving ⩾50% of their intake from formula. The following indices were then compared between the two groups. Blood glucose and serum insulin levels were used to calculate the quantitative insulin sensitivity check index (QUICKI). We also measured serum total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), apolipoprotein-A1 (apoA1) and apolipoprotein-B (apoB) levels, and the ratios of TC/HDLc, LDLc/HDLc and apoB/apoA1. The mean gestational age was 32.9 weeks at birth, and blood samples were collected at a mean corrected age of 37.4 weeks. There were 22 infants in the BM group and 19 in the MF group. QUICKI was significantly higher in the BM group. TC, HDLc and apoA1 were not significantly different between the groups, but LDLc and apoB levels were significantly higher in the BM group. The TC/HDLc, LDLc/HDLc and apoB/apoA1 ratios were significantly higher in the BM group. In preterm infants, the type of feeding exposure in the early postnatal period may influence glucose, lipid and apolipoprotein metabolism, and affect markers of MS.
Collapse
|
42
|
Pfister K, Ramel S. Optimizing Growth and Neurocognitive Development While Minimalizing Metabolic Risk in Preterm Infants. CURRENT PEDIATRICS REPORTS 2014. [DOI: 10.1007/s40124-014-0057-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
43
|
Kaseva N, Pyhälä R, Wehkalampi K, Feldt K, Pesonen AK, Heinonen K, Hovi P, Järvenpää AL, Eriksson JG, Andersson S, Räikkönen K, Kajantie E. Adrenalin, noradrenalin and heart rate responses to psychosocial stress in young adults born preterm at very low birthweight. Clin Endocrinol (Oxf) 2014; 81:231-7. [PMID: 24521432 DOI: 10.1111/cen.12425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/06/2014] [Accepted: 02/06/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Adults born preterm at very low birthweight (VLBW; ≤ 1500 g) have high levels of cardiovascular risk factors and altered responses to psychosocial stress including higher blood pressure and lower cortisol. Our aim was to investigate adrenalin (A), noradrenalin (NA) and heart rate (HR) responses to psychosocial stress in adults born preterm at VLBW. DESIGN AND PARTICIPANTS We studied 50 young adults, aged 19-27 years, born at VLBW and 39 term-born controls, group-matched for age, sex and birth hospital. They underwent a standardized psychosocial stress test, the Trier Social Stress Test (TSST). MEASUREMENTS During TSST, A, NA (baseline and 0, 10 and 90 min after stress) and HR were measured. Data were analysed with mixed-effects and linear regression models, adjusted for age, sex, body mass index, hormonal contraception, time of day and highest parental educational attainment. RESULTS Baseline concentrations, peak after stress, increments and area under the curve for A and NA were similar in VLBW and control groups. In women, NA concentrations were 27.7% lower (95% CI; 3.1-52.2) in VLBW compared with control women; in men, there was no significant difference. A concentrations were similar for VLBW and control groups in both sexes. Mean HR at baseline, task and HR reactivity was also similar in VLBW and control groups. CONCLUSIONS Very low-birthweight women seem to have a lower NA response to stress compared with term-born peers. If replicated, this could be a protective characteristic for cardiovascular diseases.
Collapse
Affiliation(s)
- Nina Kaseva
- Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Is late-preterm birth a risk factor for hypertension in childhood? Eur J Pediatr 2014; 173:751-6. [PMID: 24374732 DOI: 10.1007/s00431-013-2242-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Late-preterm birth is associated with higher rates of neonatal morbidity and mortality and higher health care utilization, but its impact on later life is not well known. In this study, we aimed to evaluate whether late-preterm birth affects blood pressure, renal function, and urinary protein excretion in children later in life. Sixty-five children aged 4 to 13 years born as late-preterm and 65 age- and sex-matched children born full term were evaluated with 24-h ambulatory blood pressure monitoring (ABPM), urinary microalbumin excretion (UAE), and glomerular filtration rate (GFR). All subjects underwent ABPM prospectively. For each gender, daytime, nighttime, and 24-h systolic and diastolic and mean blood pressures (SBP, DBP, and MAP) were transformed to standard deviation scores (SDS). Blood pressure profiles (SBP DBP, and MAP) were considered abnormal when the corresponding SDS values exceeded 1.63. Urinary microalbumin excretion was expressed as milligrams per day, and the value between 30 and 300 mg/day was defined as microalbuminuria (MA). There was no significant difference in the mean GFR and MA levels between late-preterm and term children. 24-h systolic BP SDS, daytime systolic BP SDS, nighttime systolic BP SDS, 24-h diastolic BP SDS, nighttime diastolic BP SDS, 24-h MAP BP SDS, daytime MAP BP SDS, and nighttime MAP BP SDS were found to be significantly higher in late-preterm children compared to term children. CONCLUSION We conclude that late-preterm children have higher BP levels, so those children should be followed up carefully by the pediatrician regarding probable hypertension in their future life.
Collapse
|
45
|
Siddique K, Guzman GL, Gattineni J, Baum M. Effect of postnatal maternal protein intake on prenatal programming of hypertension. Reprod Sci 2014; 21:1499-507. [PMID: 24740990 DOI: 10.1177/1933719114530186] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study examined whether postnatal maternal dietary protein deprivation during the time of nursing can program hypertension when the offspring are studied as adults. Rats were fed either a 6% or 20% protein diet during the second half of pregnancy and continued on the same diet while rats were nursing their pups. The neonates of all of the rats were cross-fostered to a different mother and studied as adults. Adult rats that had a normal prenatal environment but were reared by mothers fed a low-protein diet until weaning (20%-6%) were hypertensive, had a higher renal Na(+)-K(+)-2Cl(-) cotransporter (NKCC2) and Na(+)-Cl(-) cotransporter (NCC) protein abundance yet a comparable number of glomeruli, and had higher plasma renin and angiotensin II levels compared to control (20%-20%). Rats whose mothers were fed a 6% protein diet and cross-fostered to a different rat fed a 6% protein diet until weaning (6%-6%) were hypertensive, had elevated plasma renin and angiotensin II levels, and had a reduction in nephron number but had NKCC2 and NCC levels comparable to 20% to 20% offspring. The 6% to 20% had blood pressure and glomerular numbers comparable to 20% to 20% rats. The hypertension resulting from prenatal dietary protein deprivation can be normalized by improving the postnatal environment. Combined prenatal and postnatal maternal dietary protein deprivation and maternal dietary protein deprivation while nursing alone (20%-6%) results in hypertension, but the mechanism for the hypertension in these groups is different.
Collapse
Affiliation(s)
- Khurrum Siddique
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - German Lozano Guzman
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Jyothsna Gattineni
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Michel Baum
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| |
Collapse
|
46
|
Abstract
The first infants to experience modern pre- and neonatal care are now in their thirties, an age at which the incidence of cardiometabolic disease is low. However, data from cohorts born preterm prior to the introduction of modern care suggest an increased risk of type 2 diabetes. For young adult cohorts of former very small or very preterm infants, there is accumulating evidence of increased risk factors for later cardiovascular disease, including higher blood pressure, lower lean body mass, impaired glucose regulation, and perhaps a more atherogenic lipid profile. Regarding lifestyle, adults born very small or very preterm undertake less non-conditioning physical activity and may have a lower intake of fruit and milk products. Any intervention reducing risk factors, in particular blood pressure and low physical activity, would have a substantial potential to reduce the lifetime disease burden in small preterm infants. There are now enough data to warrant an expert evaluation of the level of evidence for cardiometabolic disease in individuals born very small or very preterm, which has possible public health implications.
Collapse
|
47
|
Abstract
The outcomes of very low birth weight survivors born in the early post-neonatal intensive care era have now been reported to young adulthood in several longitudinal cohort studies, and more recently from large Scandinavian national databases. The latter reports corroborate the findings that despite disabilities, a significant majority of very low birth weight survivors are leading productive lives, and are functioning better than expected. This is reassuring, but there are still concerns about future psychopathology, cardiovascular and metabolic problems as they approach middle age. Although these findings may not be directly applicable to the current survivors of modern neonatal intensive care, they do provide a yardstick by which to project the outcomes of future survivors until more contemporaneous data are available.
Collapse
Affiliation(s)
- Saroj Saigal
- Neonatal Follow-up Program, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
48
|
Kaseva N, Wehkalampi K, Pyhälä R, Moltchanova E, Feldt K, Pesonen AK, Heinonen K, Hovi P, Järvenpää AL, Andersson S, Eriksson JG, Räikkönen K, Kajantie E. Blunted hypothalamic-pituitary-adrenal axis and insulin response to psychosocial stress in young adults born preterm at very low birth weight. Clin Endocrinol (Oxf) 2014; 80:101-6. [PMID: 23711202 DOI: 10.1111/cen.12251] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 04/17/2013] [Accepted: 05/22/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Young adults born preterm at very low birth weight (VLBW, ≤1500 g) have higher levels of cardiovascular risk factors, including impaired glucose regulation, than their term-born peers. This could be mediated through altered hypothalamic-pituitary-adrenal axis (HPAA) response to stress. OBJECTIVE To compare HPAA, glucose and insulin responses provoked by psychosocial stress in VLBW subjects versus a comparison group of term-born controls. DESIGN AND PARTICIPANTS We studied 54 unimpaired young adults, aged 19-27 years, born at VLBW and a comparison group of 40 adults born at term, group-matched for age, sex and birth hospital, from one regional centre in southern Finland. The participants underwent a standardized psychosocial stress test (Trier Social Stress Test, TSST). MEASUREMENTS In conjunction with TSST, we measured salivary cortisol, plasma ACTH, cortisol, glucose and insulin. Data were analysed with mixed-effects model and multiple linear regression analyses. RESULTS Baseline concentrations for cortisol, ACTH, insulin and glucose were similar in VLBW and comparison groups. During TSST, analysed with mixed-effects model, overall concentrations of plasma cortisol were 17·2% lower (95% CI; 3·5 to 28·9) in the VLBW group. The VLBW group also had lower salivary (P = 0·04) and plasma cortisol (P = 0·02) responses to TSST. Insulin and glucose concentrations correlated with changes in cortisol concentrations. Accordingly, VLBW subjects had 26·5% lower increment in insulin (95% CI; 9·8-40·1). Analyses were adjusted for age, sex, body mass index, hormonal contraception, menstrual cycle phase, time of day and parental education. CONCLUSIONS VLBW adults have lower HPAA responses to psychosocial stress than term-born controls. This is accompanied by a lower insulin response.
Collapse
Affiliation(s)
- Nina Kaseva
- Department of Chronic Disease and Diabetes Prevention, National Institute for Health and Welfare, Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Sutherland MR, Bertagnolli M, Lukaszewski MA, Huyard F, Yzydorczyk C, Luu TM, Nuyt AM. Preterm Birth and Hypertension Risk. Hypertension 2014; 63:12-8. [DOI: 10.1161/hypertensionaha.113.01276] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Megan R. Sutherland
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Mariane Bertagnolli
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Amélie Lukaszewski
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Fanny Huyard
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine Yzydorczyk
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Thuy Mai Luu
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| | - Anne Monique Nuyt
- From the Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
50
|
Poon CY, Edwards MO, Kotecha S. Long term cardiovascular consequences of chronic lung disease of prematurity. Paediatr Respir Rev 2013; 14:242-9. [PMID: 24209460 DOI: 10.1016/j.prrv.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pulmonary arterial (PA) hypertension in preterm infant is an important consequence of chronic lung disease of prematurity (CLD) arising mainly due to impaired alveolar development and dysregulated angiogenesis of the pulmonary circulation. Although PA pressure and resistance in these children normalise by school age, their pulmonary vasculature remains hyper-reactive to hypoxia until early childhood. Furthermore, there is evidence that systemic blood pressure in preterm born children with or without CLD is mildly increased at school age and in young adulthood when compared to term-born children. Arterial stiffness may be increased in CLD survivors due to increased smooth muscle tone of the pre-resistance and resistance vessels rather than the loss of elasticity in the large arteries. This review explores the long term effects of CLD on the pulmonary and systemic circulations along with their clinical correlates and therapeutic approaches.
Collapse
Affiliation(s)
- Chuen Yeow Poon
- Department of Child Health, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK.
| | | | | |
Collapse
|